1Positive Health Program, San Francisco General Hospital, University of California, San Francisco, CA 94131, USA

2HIV Epidemiology and Biostatistics Group, Department of Primary Care and Population Sciences, and Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, University College London, London NW3 2PF

Treatment improves immunological function, but persistent defects—many of which are seen in advanced ageing—remain

Inflammation often remains raised during long term antiretroviral treatment; the cause and clinical relevance of this persistent inflammation are unclear

More than 25 antiretroviral drugs from six therapeutic classes are now available for the management of HIV infection (box 1). Most patients who take medication achieve durable and perhaps lifelong viral suppression, so the classic AIDS related conditions are becoming less common. However, treated patients do not have completely restored health. Compared with people without HIV infection, patients with the infection who are treated with antiretrovirals have increased risk for several “non-AIDS” complications, many of which are commonly associated with ageing (box 2). This risk is particularly evident in patients whose CD4+ T cell counts are below normal during long term treatment, but it is also seen to some extent in those with higher CD4+ T cell counts. As a consequence of the changing spectrum of HIV associated disease, the medical management of HIV infection is evolving—a lower proportion of time is now spent managing drug resistance and short term toxicities and a higher proportion is spent managing these premature age associated complications. This review discusses the evidence that the major complications of “treated” HIV disease—including cardiovascular disease, malignancy, renal disease, …